Question
What is a normal CD4 count, CD4% and CD4:CD8 ratio?
16 January 2018. Related: All topics, CD4 and viral load, Other tests.
Answer
After finding out you are HIV positive, your doctor will run several blood tests.
One will be for your immune system and will include your CD4 and CD8 count. Of these, the CD4 count is the most important main result but the CD4% and CD4:CD8 ratio are also sometimes useful.
This Q&A include information about these cels and about interpreting the test results.
CD4 cells are a type of blood cell that is part of your immune system. They are a type of white blood cell (lymphocyte). CD4 cells are sometimes called T-helper cells or T-cells
There are two main types of T-cells.
- CD4 cells, also called T4 cells, are “helper” cells. They lead the attack against infections.
- CD8 cells, (T8 cells), are “suppressor” cells that complete the immune response. CD8+ cells can also be “killer” cells that kill cancer cells and other cells that are infected by a virus.
CD4 and CD8 counts
The normal ranges for CD4 and CD8 counts vary depending on the lab and test. On average, the normal CD4 range for an HIV negative person is between 460 and 1600. This is an average. Anywhere in this range is good.
Although generally a higher CD4 is good, an HIV negative person with a normal CD4 count of 1200 is not more healthy than someone whose normal count is 400.
The exact CD4 count is not so important. CD4 counts can vary from day to day and even from hour to hour. So the general CD4 result is more important than the exact number.
A normal CD8 range is from 150 to 1000. This test is not used as much but the results come together. It is more important to know your CD4 count than your CD8 count.
CD4 percentage (CD4%)
If you get a CD4 count that is ever unexpectedly high or low, then your CD4% (CD4 percentage) can show whether this is a real change in immune function. The CD4% is a more stable marker than the absolute CD4 count.
The CD4 percentage refers to percentage of total lymphocytes that are CD4 cells. If your test reports CD4% = 34%, that means that 34% of your lymphocytes are CD4 cells.
The average normal CD4% for HIV negative adults is about 40%. However, as with CD4 counts and other test, the range for a “normal” result in an HIV negative person is also wide – from about 25% to 65%.
CD4:CD8 ratio
The CD4:CD8 ratio is also sometimes used, but less often. This is a measure of how balanced your immune function is. This calculated by dividing the CD4 result by the CD8 result.
In HIV negative people, the normal range for the CD4:CD8 ratio is between 0.9 and 1.9. This means that there are about 1 to 2 CD4 cells for every CD8 cell.
When not on HIV treatment, just like the CD4 count and CD4%, the CD4:8 ratio drops over time. Eventually, unless you start treatment, there will be more CD8 cells than CD4 cells (i.e. the ratio drops to less than 1.0).
The CD4:CD8 ratio might be better at predicting future risk in people whose CD4 count is high (above 500 cells/mm3). However, not all studies agree on this.
Other studies have shown that starting ART soon after HIV infection has a much higher chance of keeping the CD4:CD8 ratio higher than 1.0.
Note: this answer was last updated in January 2018 from a post that was originally published in December 2006.
I had an HIV test and it read me positive for the last five month haven’t been on drugs. When I tested for CD4 cells count it read 379cells I was subjected to ARVs immediately but it had made me two times weaker than I was before
Does it mean my immune system was still strong enough to mix up the drugs.
Hi,
Your CD4 count doesn’t have anything do with transmission. Viral load is the important thing here. If you get an undetectable viral load (under 50) the risk of transmission is extremely low – close to zero. You have to have been undetectable for a couple of months.
I have just started my HIV treatment at 386 CD4, if I continue my treatment and not stop my medication, if my CD4 count improves and viral load is low,can I infect my partner?
Hi Morris
I’m sorry but i-Base can’t help with diagnosing symptoms.
If your HIV doctor is not able to help with this, please ask to see a specialist who could help.
I’m HIV positive & on meds. But I have a spinal cold pain for 10 years & have been tested saveral time but the problem has never been found. what could be the couse of this pain.
Hi,
It is great that your CD4 count is still so high. However this does not have any impact on risks of transmission. Your viral load, not your CD4, tells you about risks of transmission. If you are on treatment and have an ‘undetectable’; viral load risks of transmission are extremely low. Because you are not on treatment your viral load will be higher so there is a risk of transmission Happening. There is no risk of transmission if you use a condom.
Hi
My cd4 count is till high(1234) it’s possible to transmit the virus to my partner. I haven’t been on the meds yet.
Hi,
CD4 count is quite variable. Lots of things can affect it. Even the time of day you get tested or whether you have eaten or not. One result like this where your CD4 has gone down is not necessarily something you have to worry about. Particularity if your viral load is undetectable. Doctors tend to look at a number of CD4 counts over time to look for patterns, rather than single results.
Hi, why does my CD4 not go up even when my viral load is undetectable. The highest its been is 382, but it went down to 312.
Hi Owen
It is nearly always a shock to find out that you are HIV positive.
It is good that you were diagnosed so early though and that you had the chance to start early treatment. Many researchers think that this might be much better for you.
So long as your side effects are mild and manageable, they usually get easier after the first few weeks. If they continue to be a problem, there are lots of other HIV combinations that you can use.
Even though everything is still very tough, it will get much easier.
It is difficult yo comment on the rash but your doctor should take this seriously. IF it is already getting easier this might mena it is okay to continue on the same meds.